Artikel
LINAC-radiosurgery for arteriovenous malformations of the brain stem and thalamus
LINAC-Radiochirurgie zur Behandlung von arteriovenösen Malformationen in Hirnstamm und Thalamus
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Autoren
Veröffentlicht: | 23. April 2004 |
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Gliederung
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Objective
The presented retrospective analysis was addressed to the efficiency of LINAC-radiosurgery (LINAC-RS) in arteriovenous malformations (AVMs) of highly-eloquent deep brain areas like the brains stem, thalamus or basal ganglia with regard to radiation dose, Spetzler/Martin grading and diameter of the nidus.
Methods
53/95 patients treated from 11/90 to 5/03 with a follow-up of ≥18 months were analysed retrospectively. A median single dose of 20 Gy (range: 9-25 Gy) was applied to the surface of the AVM nidus, which was delineated on stereotactic angiograms. Isocenters. Width of the collimators and dose distribution were calculated and controlled 3-dimensionally on stereotactic tomographic images (stereotactic CT and MRI). Regular follow-up investigations included assessment of the neurological status as well as MRI and angiographic examinations.
Results
The malformations were graded according to Spetzler/Martin (Grade II: n=2, Grade III: n=36, Grade IV: n=13). Follow-up angiography documented obliteration in n=32/41 patients (78%) and partial obliteration or persisting venous drainage in n=9/41 patients. Obliteration was correlated with high radiation dose (≤15 Gy: n=7/11, 63.3%; >15 Gy: n=25/30, 83.3%) low Spetzler/Martin grading (Grade II-III: n=28/31, 90.3%; Grade IV: n=3/9, 33.3%) and small diameter of the nidus (≤30 mm: n=25/27, 92.6%; > 30mm: n=3/10, 30%).
Conclusions
LINAC-RS with doses >15 Gy is highly effective for the treatment of AVM in highly-eloquent areas like the brain stem, thalamus or basal ganglia with Spetzler/ Martin-Grades <IV or diameters <30 mm. In large AVMs LINAC-RS with moderate doses yields obliteration rates of about 30%.